tailieunhanh - Báo cáo y học: "Bench-to-bedside review: Therapeutic options and issues in the management of ventilator-associated bacterial pneumonia"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Bench-to-bedside review: Therapeutic options and issues in the management of ventilator-associated bacterial pneumonia. | Available online http content 9 3 259 Review Bench-to-bedside review Therapeutic options and issues in the management of ventilator-associated bacterial pneumonia Jordi Rello Critical Care Department Joan XXIII University Hospital University Rovira i Virgili Institut Pere Virgili Tarragona Spain Corresponding author Jordi Rello jrc@ Published online 30 November 2004 This article is online at http content 9 3 259 2004 BioMed Central Ltd Critical Care 2005 9 259-265 DOI cc3014 Abstract Despite progress in the diagnosis prevention and therapy for hospital-acquired infections ventilator-associated pneumonia VAP continues to complicate the course of a significant proportion of patients receiving mechanical ventilation. Mortality rates among patients with VAP have been reported to be as high as 72 and the morbidity associated with VAP is also considerable adding days to the hospital stay and increasing health care costs. Appropriate initial antimicrobial therapy for patients with VAP has been shown to reduce mortality rates and improve outcomes therefore rapid identification of infected patients and timely accurate selection of effective antimicrobial agents are important clinical goals. The primary organisms responsible for VAP include Enterobacteriaceae Pseudomonas aeruginosa and Staphylococcus aureus. However aetiologies differ considerably between intensive care units and the increase in antibiotic resistance and nosocomial outbreaks worldwide have presented clinicians with a serious dilemma with respect to selecting appropriate empirical therapy. To date no optimal antimicrobial regimen for the treatment of VAP has been identified largely because none of the currently marketed antibiotics has a sufficiently extended spectrum of activity to cover all of the potential key pathogens. More active less toxic antibacterial agents are still needed in particular to combat problematic pathogens such as multiresistant .